The Nation: The Most Common Mental Disorder

DEPRESSION is such a commonly used term and such a frequently experienced mood that there probably would have been no great national concern if it had been learned that Thomas Eagleton had merely sought medical help to shake such a state of mind. But the revelation that his condition had been considered by some doctors clinically serious enough to require electric-shock treatments twice sounded alarming. To many people, that smacks of a radical, frightening assault on the brain that would only be used in desperate circumstances. In fact, both the illness and the remedy are surprisingly commonplace. A panel of experts convened by the American Psychiatric Association to help handle press queries after Eagleton's medical history was revealed calls depression "the most common form of mental disorder." Every year doctors treat some 4,000,000 to 8,000,000 Americans for it; about 250,000 of the cases require hospitalization. No one knows how many undergo shock therapy, which, like the illness, remains in some ways mysterious. Explains Dr. Lothar Kalinowsky, a New York City psychiatrist who was one of the pioneers of electroconvulsive therapy in the U.S.: "We must admit that we are very successfully treating conditions of an unknown cause with treatments of an equally unknown mode of action."

There is no clear-cut medical definition of depression (which used to be known as melancholia). No consensus exists on whether it is merely an aggravated degree of the sadness or "blues" that everyone feels at times, whether it stems from some deeply rooted inner psychological condition, or whether it has a biochemical origin in the body. Pragmatically, it tends to be defined by its symptoms: feelings of worthlessness, guilt and anxiety; an inability to find pleasure in normal activities; early-morning sleeplessness; fatigue and change of weight; and occasionally, serious consideration of suicide. When a person's feelings do not seem to be justified by his actual circumstances, and when they interfere with his functioning, he is considered ill.

Shock treatment is not a new technique in treating depression. Modern electroconvulsive therapy was developed by Italian psychiatrists in the late 1930s. They acted on others' observations that patients who developed spontaneous convulsions, as in high fevers, seemed to become less melancholic. Shock therapy in effect artificially throws the body into a brief convulsion.

As practiced today, shock treatments are administered through electrodes attached to the patient's temples. A device the size of a file-card box is used to send an alternating current of about 400 milliamperes through the brain at roughly 100 volts for seven seconds (electric chairs employ a seven-ampere current at 50,000 volts). The resulting convulsion lasts less than a minute. The patient is protected by both muscle-relaxant drugs and anesthesia against one of shock treatment's early hazards: the possibility of arm or leg fractures. The patient experiences loss of recent memory when he regains consciousness, but memory returns quickly to all but elderly patients.